Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal.
University of Tartu, Tartu University Hospital, Tartu, Estonia.
PLoS One. 2021 May 13;16(5):e0251498. doi: 10.1371/journal.pone.0251498. eCollection 2021.
Liver cirrhosis and ascites are risk factors for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS); however, data is scarce. We aimed to determine the prevalence of IAH/ACS in a population of critically ill cirrhotic patients with acute medical illness in intensive care and to assess for risk factors and clinical outcomes.
This was a multicentric retrospective cohort study including two general ICUs and pooled data from a multicentric study between January 2009 and October 2019.
A total of 9,345 patients were screened, and 95 were included in the analysis. Mean age was 56.7±1.3 years, and 79% were male. Liver cirrhosis etiology included alcohol in 45.3% and alcohol plus hepatitis C virus in 9.5%. Precipitating events included infection in 26% and bleeding in 21% of cases. Mean severity score MELD and SAPS II were 26.2±9.9 and 48.5±15.3, respectively, at ICU admission. The prevalence of IAH and ACS was respectively 82.1% and 23.2% with a mean value of maximum IAP of 16.0±5.7 mmHg and IAH grades: absent 17.9%, I 26.3%, II 33.7%, III 17.9%, and IV 4.2%. Independent risk factors for IAH were alcoholic cirrhosis (p = 0.01), West-Haven score (p = 0.01), and PaO2/FiO2 ratio (p = 0.02); as well as infection (p = 0.048) for ACS. Overall, 28-day mortality was 52.6% associated with higher IAP and ACS, and independent risk factors were MELD (p = 0.001), white blood cell count (p = 0.03), PaO2/FiO2 ratio (p = 0.03), and lactate concentration (p = 0.04) at ICU admission.
This study demonstrates a very high prevalence of IAH/ACS in the critically ill cirrhotic patient in intensive care. Increased IAP and ACS were associated with severity of disease and adverse outcomes and independent risk factors for IAH were alcoholic cirrhosis, hepatic encephalopathy and PO2/FiO2 ratio, as well as infection for ACS. Early diagnosis, prevention, and treatment of IAH/ACS might improve outcome in critically ill cirrhotic patients.
肝硬化和腹水是腹腔内高压（IAH）和腹腔间隔室综合征（ACS）的危险因素；然而，相关数据较为缺乏。我们旨在确定 ICU 中患有急性内科疾病的危重肝硬化患者中 IAH/ACS 的患病率，并评估其危险因素和临床结局。
这是一项多中心回顾性队列研究，包括两个普通 ICU，并汇集了 2009 年 1 月至 2019 年 10 月期间进行的一项多中心研究的数据。
共筛选了 9345 名患者，其中 95 名纳入分析。患者平均年龄为 56.7±1.3 岁，79%为男性。肝硬化病因包括酒精性 45.3%和酒精性加丙型肝炎病毒感染 9.5%。诱发事件包括感染占 26%，出血占 21%。入 ICU 时，平均 MELD 和 SAPS II 评分分别为 26.2±9.9 和 48.5±15.3。IAH 和 ACS 的患病率分别为 82.1%和 23.2%，最大 IAP 平均值为 16.0±5.7mmHg，IAH 分级为：无 17.9%，I 级 26.3%，II 级 33.7%，III 级 17.9%，IV 级 4.2%。IAH 的独立危险因素为酒精性肝硬化（p = 0.01）、West-Haven 评分（p = 0.01）和 PaO2/FiO2 比值（p = 0.02）；感染（p = 0.048）是 ACS 的独立危险因素。总体而言，28 天死亡率为 52.6%，与较高的 IAP 和 ACS 相关，独立危险因素为 MELD（p = 0.001）、白细胞计数（p = 0.03）、PaO2/FiO2 比值（p = 0.03）和乳酸浓度（p = 0.04）。
本研究表明，ICU 中患有严重肝硬化的患者中 IAH/ACS 的患病率非常高。较高的 IAP 和 ACS 与疾病严重程度和不良结局相关，IAH 的独立危险因素为酒精性肝硬化、肝性脑病和 PO2/FiO2 比值，ACS 的独立危险因素为感染。早期诊断、预防和治疗 IAH/ACS 可能改善危重肝硬化患者的结局。
